As a major structural reform, the management of HIV prevention and control programme was decentralised to district level during the third phase (2007-12) of National AIDS Control Programme-III in the years 2008-09. Using the HIV Sentinel Surveillance data (2004-2006), all the districts in the country were divided into four categories (Category A, B, C and D) based on the disease burden. As per this, there were 156 Category A and 39 Category B districts (total 195 districts) across the country (22 states) that required priority attention. National AIDS Control organization (NACO) established DAPCUs in 188 of the 195 districts to provide programmatic oversight through decentralized facilitation, monitoring and coordination of HIV/AIDS programme activities in the district.
DAPCU structure and roles
DAPCU is the eye and ears of NACO and State AIDS Control Societies (SACS) with a cross cutting management structure that coordinates with all the HIV facilities in the district. The DAPCU is headed by a public health officer of the rank of Deputy Chief Medical & Health Officer known as District AIDS Control Officer. S/he is supported by a team of five people hired on a contractual basis. The major responsibility of DAPCU is facilitation, monitoring and coordination of NACP activities at the district and sub- district level by integrating it with the health system to the extent possible for better synergy and optimal results.
Key functions of DAPCUs
- DAPCUs, through active engagement of the district administration mobilise response from allied line departments and private sector in mainstreaming the programme.
- Initiates evidence based district-specific initiatives by leveraging local resources.
- Facilitates in linking vulnerable population with various social entitlement and welfare schemes under the mechanism of DAPCU led single window approach.
- DAPCUs mentors facility staff in efficient delivery of services, conducts impact monitoring through regular supervisory visits to HIV facilities, monthly review meetings and management and use of multiple databases (SIMS/MCTS/PCTS).
- Based on these regular monitoring mechanisms, DAPCUs coordinate among NACP as well as NHM facilities and functionaries in strengthening referrals and linkages.
- Apart from these, DAPCUs address supply chain management issues through inter and intra-district transfers and liquidation of advance.
- Other activities entrusted by SACS such as setting up of FICTCs in both Government and PPP mode, facilitating Migrant Health Camps, Mid-media campaigns under IEC program, preparation of district epidemiological profile are also part of their functions
NACO manages functioning of DAPCUs through DAPCU National Resource Team (DNRT) which was created in 2010-11.
National Technical Support Unit (NTSU), with technical and funding support from Centers for Disease Control and Prevention, developed a standardised training programme for DAPCU staff and trained all the staff during 2010-11 and then in 2014-15 during NACP-IV. The DNRT has experienced professionals with diverse experience in managing public health programmes and has been functioning under the continuous guidance of NACO. The team has 12 members on board who are regionally placed for providing effective oversight to the states and districts. DNRT provides continuous mentoring and support to the DAPCUs and actively guides DAPCU activities.
Each state is responsible for managing their DAPCUs, which includes hiring and retention of staff, capacity building and providing supportive supervision and day-to-day management. One of the senior officers of SACS, preferably, the Additional Project Director (APD), or in case the APD position is vacant; Joint Director- Basic Services is designated as the DAPCU Nodal Officer (DNO). NACO conducts periodical review of the programme using various forums. With continuous evolution of the programme and changing priorities in NACP IV (2012-17), DAPCU’s role has also evolved. To capacitate the staff to meet with the growing demands of the programme, DNRT in close coordination with NACO and CDC developed training modules. All the staff were trained in several phases across FY 2014-15 and FY 2015-16 by the respective SACS with technical support by the DNRT using these standard training modules. DNRT, in close coordination with the DNOs in SACS make need-based visits to DAPCUs to mentor the staff and motivate them to continue with their challenging task of coordinating and monitoring of NACP activities, address the programmatic gaps to realize the programme goals and objectives.
The fact that more than 65% of the total HIV facilities in the country are located in the high-burden districts, provides scope for a positive impact on the NACP through optimal and effective engagement of the DAPCUs.
To promote wider sharing of knowledge within the districts, different platforms have been created. One of them was identification of successful approaches and models, documenting them as case studies and sharing them widely with all the DAPCU staff in the form of “DAPCU Series”. This practice encouraged many DAPCUs to document and present their achievements to SACS and NACO through DAPCU Series. While it is difficult to include all the experiences through this mode, the need for a larger space was felt. “DAPCU SPEAK” http://dapcuspeak.blogspot.in, is another initiative that emerged from this experience. DAPCU Speak, a moderated blog started in February 2012, is to promote sharing of DAPCUs experiences.
DAPCUs in Delhi have taken a lead in the ongoing South to South Knowledge exchange initiative by facilitating and coordinating onsite learning and knowledge transfer visits by delegates from other countries such as Tanzania, Geneva, Benin Cameroon in 2015-16 and South Korea in May’2016.
DAPCUs role in strengthening NACP
DAPCUs have been playing a pivotal role in strengthening the NACP and some of the achievements include:
DAPCUs are conducting monthly review meetings with district HIV/AIDS facilities staff regularly to take stock of the programme, identify and resolve system level bottlenecks to improve reporting, referrals and linkages.
Many DAPCUs have been using the platform of quarterly District AIDS Prevention and Control Committee (DAPCC) meetings to involve district administration in the HIV programme. District Collector chairs this meeting which engages allied departments and leverage resources to address non-health needs of PLHIV and HRGs.
DAPCUs have identified Government facilities in the districts (PHC/CHC/Dispensaries) and Private hospitals to facilitate setting up of FICTC’s, thus scaling up HIV screening services.
For meeting the objectives of the PPTCT program, DAPCUs have coordinated and facilitated capacity building trainings of MOs/ANM/LT/ASHA workers under NHM in their respective districts towards enhancing the HIV screening services.
Presence of DAPCUs in high prevalent districts have proved to be pivotal in management of NACP activities at the field level